Department of Pediatrics, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Pediatrics. 2024 Aug 1;154(Suppl 1). doi: 10.1542/peds.2024-066588G.
Pneumonia is a leading cause of death in young infants.
To evaluate the efficacy of different antibiotic regimens to treat young infant pneumonia on critical clinical outcomes.
MEDLINE, Embase, CINAHL, World Health Organization (WHO) Global Index Medicus, Cochrane Central Registry of Trials.
We included randomized controlled trials of young infants aged 0 to 59 days with pneumonia (population) comparing the efficacy of antibiotic regimens (intervention) with alternate regimens or management (control) on clinical outcomes.
We extracted data and assessed risk of bias in duplicate. We used Grading of Recommendations, Assessment, Development, and Evaluation to assess certainty of evidence.
Trials were heterogeneous, which precluded data pooling.
Of 2601 publications screened, 10 randomized controlled trials were included. Seven trials were hospital-based (n = 869) and 3 were nonhospital-based (n = 4329). No hospital-based trials evaluated WHO-recommended first-choice regimens. One trial found the WHO-recommended second-choice antibiotic, cefotaxime, to have similar rates of treatment success as non-WHO-recommended regimens of either amoxicillin-clavulanate (RR 0.99, 95% confidence interval 0.82-1.10) or amoxicillin-clavulanate/cefotaxime (RR 1.02, 95% confidence interval 0.86-1.12). Among 3 nonhospital-based trials comparing oral amoxicillin to alternate regimens to treat isolated tachypnea among infants aged 7-59 days, there were no differences in treatment failure between amoxicillin and alternate regimens. Certainty of evidence was low or very low for all primary outcomes.
We found limited evidence to support the superiority of any single antibiotic regimen over alternate regimens to treat young infant pneumonia.
肺炎是导致婴幼儿死亡的主要原因。
评估不同抗生素方案治疗婴幼儿肺炎对关键临床结局的疗效。
MEDLINE、Embase、CINAHL、世界卫生组织（WHO）全球医学索引、Cochrane 对照试验中心注册库。
我们纳入了年龄在 0 至 59 天的患有肺炎的婴幼儿（人群）的随机对照试验，比较了抗生素方案（干预）与替代方案或管理（对照）在临床结局方面的疗效。
我们重复提取数据并评估偏倚风险。我们使用推荐评估、制定与评价分级法（Grading of Recommendations, Assessment, Development, and Evaluation）评估证据的确定性。
试验存在异质性，因此无法进行数据合并。
在筛选的 2601 篇文献中，有 10 项随机对照试验被纳入。7 项试验为医院内研究（n=869），3 项为非医院内研究（n=4329）。没有医院内研究评估了世界卫生组织推荐的一线方案。一项试验发现，世界卫生组织推荐的二线抗生素头孢噻肟与非世界卫生组织推荐的阿莫西林-克拉维酸（RR 0.99，95%置信区间 0.82-1.10）或阿莫西林-克拉维酸/头孢噻肟（RR 1.02，95%置信区间 0.86-1.12）方案的治疗成功率相似。在 3 项比较 7-59 天龄单纯呼吸急促的婴儿口服阿莫西林与替代方案的非医院内试验中，阿莫西林与替代方案在治疗失败方面没有差异。所有主要结局的证据确定性均为低或极低。
我们发现，支持任何单一抗生素方案优于替代方案治疗婴幼儿肺炎的证据有限。
